Surgical Skill and Complication Rates after Bariatric Surgery
Surgical Skill and Complication Rates after Bariatric Surgery
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DOI：
10.1056/nejmsa1300625
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发表时间：
2013-10-10
影响因子：
158.5
通讯作者：
Birkmeyer, Nancy J. O.
中科院分区：
文献类型：
--
作者：
Birkmeyer, John D.;Finks, Jonathan F.;Birkmeyer, Nancy J. O.
背景：许多复杂外科手术后的临床结果在不同的医院和外科医生之间差异很大。尽管人们一直认为手术医生的熟练程度是造成这种差异的重要因素，但缺乏关于技术技能与术后结果之间关系的经验数据。方法我们在密歇根州进行了一项涉及20名减肥外科医生的研究，他们参加了一项全州范围的合作改善计划。每位外科医生提交了一份他或她自己进行腹腔镜胃旁路手术的代表性录像带。每盘录像带在不同领域的技术技能上被打分，从1到5分（分数越高表明技术越先进），由至少10名不知道主刀医生身份的同行外科医生打分。然后，我们评估了这些技能等级与风险调整并发症发生率之间的关系，使用来自前瞻性、外部审计、临床结果登记的数据，涉及10,343名患者。结果20名外科医生的平均综合技术评分为2.6 - 4.8分。手术技能最低的四分位数与最高的四分位数相比，并发症发生率更高(14.5%比5.2%，P
BackgroundClinical outcomes after many complex surgical procedures vary widely across hospitals and surgeons. Although it has been assumed that the proficiency of the operating surgeon is an important factor underlying such variation, empirical data are lacking on the relationships between technical skill and postoperative outcomes.MethodsWe conducted a study involving 20 bariatric surgeons in Michigan who participated in a statewide collaborative improvement program. Each surgeon submitted a single representative videotape of himself or herself performing a laparoscopic gastric bypass. Each videotape was rated in various domains of technical skill on a scale of 1 to 5 (with higher scores indicating more advanced skill) by at least 10 peer surgeons who were unaware of the identity of the operating surgeon. We then assessed relationships between these skill ratings and risk-adjusted complication rates, using data from a prospective, externally audited, clinical-outcomes registry involving 10,343 patients.ResultsMean summary ratings of technical skill ranged from 2.6 to 4.8 across the 20 surgeons. The bottom quartile of surgical skill, as compared with the top quartile, was associated with higher complication rates (14.5% vs. 5.2%, P